- Email: [email protected]
604 Long Term Follow-Up of Implantable Loop Recorders: Prolonging Observation Period Increases Diagnostic Yield?
S323
Abstracts
It is an atrial selective drug with both potassium and sodium channel blocking properties. We performed a meta-analysis of randomized controlled trials of Vernakalant to examine its efficacy and safety. METHODS: We performed a literature search of MEDLINE, EMBASE and the Cochrane Controlled Trials Register for all randomized trials of Vernakalant versus placebo/anti-arrhythmic (AAD) drug in the acute treatment of recent-onset (3 hours to 45 days) AF. The primary endpoint in all trials was the conversion of AF to sinus rhythm within 90minutes of drug administration. Two independent authors performed the data extraction. Review Manager 5.1 (Cochrane Collaboration) was used to perform the statistical analysis. RESULTS: Five randomized clinical trials (trial acronyms: ACT I, ACT II, ACT III, AVRO, CRAFT) met the inclusion criteria. Four trials compared intravenous Vernakalant to placebo and 1 trial compared intravenous Vernakalant to intravenous Amiodarone (Table 1). A total of 959 patients were included. No significant heterogeneity was found across the trials (I2⫽31%). Conversion to sinus rhythm within 90 minutes occurred in 246 patients out of 573 patients (42.9%) in the Vernakalant group compared to 21 out of 386 patients (5.4%) in the placebo/Amiodarone group. Vernakalant was associated with a significantly higher cardioversion rate compared to the placebo/Amiodarone (relative risk 7.7; CI: 4.5-13.0; P⬍0.00001). A total of 40 serious adverse events out of 596 patients (6.7%) occurred in the Vernakalant group compared to 33 serious adverse effects out of 396 patients (8.3%) in the placebo/Amiodarone group. CONCLUSION: Vernakalant is effective in the acute conversion of recent-onset AF to sinus rhythm. The drug appears to be welltolerated with no increase in major adverse events compared to placebo/Amiodarone. Table 1.
extending observation period. The aim of our study is to evaluate the diagnostic value of ILR during very prolonged observation, reporting cardiovascular and arrhythmic events in those patients without syncopal recurrence during initial monitorization. METHODS: All patients who underwent ILR (Reveal/plus/DX, Medtronic Inc.) in our center 1998-2006, with follow-up in our Syncope Clinic, were included in the study. RESULTS: 163 patients (103 male, 64,9⫹/⫺1,5 yo) were included. ILR was diagnostic in 51 patients. Arrhythmic cause was identified 37 cases, [22,7%, median follow-up 4,41⫹/⫺0,7 months (rank 1,21-12,44)]; and non-arrhythmic cause in 14. In 112 patients the device was explanted without reaching final diagnosis after mean implant period of 15,02 ⫹/⫺0,6 months (maximum 50,2). These 112 patients were followed during a mean period of 6,02⫹/⫺0,26 years. During follow up, 27 (24%) experienced new syncopal episodes, 40,5 months post-explantation (mean IC95% 27,5-53,5): 10 considered cardiogenic, 11 benignneuromediated syncope, 2 neurologic, and 4 of unknown origin. 29 (25.9%) patients died during follow-up, none of them of arrhythmic cause. CONCLUSION: Event rate after ILR explantation is very high. Prolonging observation period to 4 years may increase diagnostic yield in patients with syncope of unknown etiology. In patients who underwent ILR implantation, monitorization period should be maintained even several years until a final diagnosis is reached.
605 A FOUR-YEAR POPULATION BASED ANALYSIS OF EMERGENCY DEPARTMENT SYNCOPE: PREDICTORS OF ADMISSION/READMISSION, AND REGIONAL VARIATIONS IN PRACTICE PATTERNS X Feng, Z Tian, B Rowe, A McRae, V Thiruganasambandamoorthy, R Rosychuk, R Sheldon, E Lang Calgary, Alberta
604 LONG TERM FOLLOW-UP OF IMPLANTABLE LOOP RECORDERS: PROLONGING OBSERVATION PERIOD INCREASES DIAGNOSTIC YIELD? V Exposito, F Rodriguez-Entem, S González-Enríquez, P Lerena, JM Gomez-Delgado, B Arnaez, JJ Olalla Santander, Spain
Average diagnostic yield of implantable loop recorders (ILR) is reported to be 35% in selected populations over an observation period of 12-18 months. In recent years new devices have been developed, allowing extending monitoring time. However, there are no conclusive data on the potential benefits of
BACKGROUND:
BACKGROUND: Syncope is a common and potentially high risk Emergency Department (ED) presentation. There are no Canadian and few international population-based studies of ED syncope and its heterogeneity in care. The goals of this study were to determine 1) the volume of ED syncope presentations and readmission to ED within 7 days; 2) the proportion admitted as inpatients (IP); 3) the heterogeneity among hospital types in proportion of syncope 7-day readmissions to ED and admissions as inpatients; and 4) identify factors associated with ED readmissions and IP admissions. METHODS/RESULTS: This was a multi-center retrospective cohort study using electronic administrative data from all 101 Albertan EDs for patients ⬎17 years of age with International Classification of Disease (ICD)-10 diagnosis of syncope (R55) as a primary or secondary diagnosis, with sampling period 2007-Jun 2011 inclusive. The data were provided by Alberta Health Services Data Integration, Measurement and Reporting. Urban status was defined as hospitals located in Edmonton and Calgary. Independent variables were factors associated with index visit IP hospitalization, and with ED revisits or
Abstracts
It is an atrial selective drug with both potassium and sodium channel blocking properties. We performed a meta-analysis of randomized controlled trials of Vernakalant to examine its efficacy and safety. METHODS: We performed a literature search of MEDLINE, EMBASE and the Cochrane Controlled Trials Register for all randomized trials of Vernakalant versus placebo/anti-arrhythmic (AAD) drug in the acute treatment of recent-onset (3 hours to 45 days) AF. The primary endpoint in all trials was the conversion of AF to sinus rhythm within 90minutes of drug administration. Two independent authors performed the data extraction. Review Manager 5.1 (Cochrane Collaboration) was used to perform the statistical analysis. RESULTS: Five randomized clinical trials (trial acronyms: ACT I, ACT II, ACT III, AVRO, CRAFT) met the inclusion criteria. Four trials compared intravenous Vernakalant to placebo and 1 trial compared intravenous Vernakalant to intravenous Amiodarone (Table 1). A total of 959 patients were included. No significant heterogeneity was found across the trials (I2⫽31%). Conversion to sinus rhythm within 90 minutes occurred in 246 patients out of 573 patients (42.9%) in the Vernakalant group compared to 21 out of 386 patients (5.4%) in the placebo/Amiodarone group. Vernakalant was associated with a significantly higher cardioversion rate compared to the placebo/Amiodarone (relative risk 7.7; CI: 4.5-13.0; P⬍0.00001). A total of 40 serious adverse events out of 596 patients (6.7%) occurred in the Vernakalant group compared to 33 serious adverse effects out of 396 patients (8.3%) in the placebo/Amiodarone group. CONCLUSION: Vernakalant is effective in the acute conversion of recent-onset AF to sinus rhythm. The drug appears to be welltolerated with no increase in major adverse events compared to placebo/Amiodarone. Table 1.
extending observation period. The aim of our study is to evaluate the diagnostic value of ILR during very prolonged observation, reporting cardiovascular and arrhythmic events in those patients without syncopal recurrence during initial monitorization. METHODS: All patients who underwent ILR (Reveal/plus/DX, Medtronic Inc.) in our center 1998-2006, with follow-up in our Syncope Clinic, were included in the study. RESULTS: 163 patients (103 male, 64,9⫹/⫺1,5 yo) were included. ILR was diagnostic in 51 patients. Arrhythmic cause was identified 37 cases, [22,7%, median follow-up 4,41⫹/⫺0,7 months (rank 1,21-12,44)]; and non-arrhythmic cause in 14. In 112 patients the device was explanted without reaching final diagnosis after mean implant period of 15,02 ⫹/⫺0,6 months (maximum 50,2). These 112 patients were followed during a mean period of 6,02⫹/⫺0,26 years. During follow up, 27 (24%) experienced new syncopal episodes, 40,5 months post-explantation (mean IC95% 27,5-53,5): 10 considered cardiogenic, 11 benignneuromediated syncope, 2 neurologic, and 4 of unknown origin. 29 (25.9%) patients died during follow-up, none of them of arrhythmic cause. CONCLUSION: Event rate after ILR explantation is very high. Prolonging observation period to 4 years may increase diagnostic yield in patients with syncope of unknown etiology. In patients who underwent ILR implantation, monitorization period should be maintained even several years until a final diagnosis is reached.
605 A FOUR-YEAR POPULATION BASED ANALYSIS OF EMERGENCY DEPARTMENT SYNCOPE: PREDICTORS OF ADMISSION/READMISSION, AND REGIONAL VARIATIONS IN PRACTICE PATTERNS X Feng, Z Tian, B Rowe, A McRae, V Thiruganasambandamoorthy, R Rosychuk, R Sheldon, E Lang Calgary, Alberta
604 LONG TERM FOLLOW-UP OF IMPLANTABLE LOOP RECORDERS: PROLONGING OBSERVATION PERIOD INCREASES DIAGNOSTIC YIELD? V Exposito, F Rodriguez-Entem, S González-Enríquez, P Lerena, JM Gomez-Delgado, B Arnaez, JJ Olalla Santander, Spain
Average diagnostic yield of implantable loop recorders (ILR) is reported to be 35% in selected populations over an observation period of 12-18 months. In recent years new devices have been developed, allowing extending monitoring time. However, there are no conclusive data on the potential benefits of
BACKGROUND:
BACKGROUND: Syncope is a common and potentially high risk Emergency Department (ED) presentation. There are no Canadian and few international population-based studies of ED syncope and its heterogeneity in care. The goals of this study were to determine 1) the volume of ED syncope presentations and readmission to ED within 7 days; 2) the proportion admitted as inpatients (IP); 3) the heterogeneity among hospital types in proportion of syncope 7-day readmissions to ED and admissions as inpatients; and 4) identify factors associated with ED readmissions and IP admissions. METHODS/RESULTS: This was a multi-center retrospective cohort study using electronic administrative data from all 101 Albertan EDs for patients ⬎17 years of age with International Classification of Disease (ICD)-10 diagnosis of syncope (R55) as a primary or secondary diagnosis, with sampling period 2007-Jun 2011 inclusive. The data were provided by Alberta Health Services Data Integration, Measurement and Reporting. Urban status was defined as hospitals located in Edmonton and Calgary. Independent variables were factors associated with index visit IP hospitalization, and with ED revisits or